Jean Wendrick acknowledges that she’s been mostly unhealthy her whole life—suffering from diabetes since she was in her 20s and overcoming breast cancer more recently.
At a doctor’s appointment last year, Ms. Wendrick learned she has osteopenia, a condition in which her body isn’t making new bone cells quickly enough, which often leads to osteoporosis. Her doctor suggested medication—the same type her mother has been taking.
“It was devastating to me,” she said. “My mom is hunched over with osteoporosis and can only look at the floor. She’s in so much pain, and she took all the meds. It was all for nothing.”
While Ms. Wendrick can see her potential future when looking at her 86-year-old mother, she also finds reasons, when thinking of her 18-year-old daughter, Victoria, whom she had at age 47, to make the changes that can restore her health.
The Doctor’s Dilemma
Ms. Wendrick’s experience is common. Facing devastating illness, patients are offered drugs that have little effect and create problems that patients may never be told about.
While some doctors will do little beyond suggesting surgery or a new prescription, many others do recommend their patients make lifestyle changes to fundamentally resolve the cause of chronic conditions.
However, all too often, these recommendations come as brief commands to “lose weight,” “exercise more,” or “eat better” and are often served with a sprinkle of judgment.
Health care providers may then blame patients for their inability to follow such orders.
“A majority [of both physicians and nurses] agreed that a major barrier to the treatment of lifestyle-related conditions is patients’ unwillingness to change their habits,” the study states.
“Everybody basically wants to lead a healthy life,” Dr. Lindsay told Scope, “but there are different beliefs and obstacles that contribute to ambivalence.”
Helping patients overcome those beliefs and navigate those obstacles simply isn’t in the job description for many health care practitioners.
One part of the issue is a lack of time. Another part of the issue is that physicians simply don’t know how to help patients or communicate these issues well. Many doctors have no meaningful relationship with the people whose lives depend on them.
Physicians who learn how to communicate well are more than twice as effective in getting patients to make lifestyle changes, said Dr. Lindsay.
A Different Approach to Medicine
Making changes requires patients to take responsibility—and health care practitioners to effectively support that change, say experts.“Before I had excuses. I ate what I wanted when I wanted, and I was eating for emotions. I always had symptoms. I didn’t do any exercise. It was awful,” Ms. Wendrick recalled. “Now, there is a reason for me to get up in the morning and finally take care of me. I know it takes discipline and determination to get results.”
Ms. Wendrick is on a mission to get her diabetes under control, lose weight, and strengthen her bones. She hired a new doctor to help her succeed, Dr. Scott Doughty, a family doctor at U.P. Holistic Medicine in Michigan. Ms. Wendrick calls him “the boss.” She’s lost 30 pounds so far and said she feels like she’s in her 20s.
For the first time in her health care experience, Ms. Wendrick felt listened to and that she had suitable options and a support system that would allow her to avoid the poor prognosis she was facing. It became easier for her to comply because she felt in control and supported by Dr. Doughty, she said.
Ms. Wendrick isn’t an exception. Patient engagement, motivation, and support are vital ingredients for healing disease from the standpoint of functional medicine and research studies.
The AMA also raises the need for an engaging coach, someone capable of getting patients to participate in lifestyle programs.
Medicinal Commands
A 2019 study revealed that a shared power balance between patients and health care providers was critical to active patient participation and adherence to treatment in chronic illnesses.
Telling people they need to “stop this or stop that” almost universally fails, Dr. Joel Evans, founder and director of the Center for Functional Medicine, told The Epoch Times. It’s more effective, he said, to find beneficial things to add to behavior such as eating more fruits and vegetables.
“By talking to patients this way, they feel more cared for, and they’re more likely to participate in the creation of a plan ... and they’re more likely to follow the plan,” Dr. Evans said. “The doctor dictator doesn’t work.”
Doctors As Dictators
Physicians find themselves in an impossible bind. They often believe they must convey a sense of certainty and authority to give their patients confidence in prescribed treatments—and yet there is little certainty in medicine. This can lead to issuing orders rather than engaging patients in more meaningful conversations.
Consolidation among these businesses is leading to fewer and fewer of these corporations, which become ever larger, leaving physicians with fewer employment possibilities and less autonomy. In other words, doctors may have fewer options in how they treat patients.
This situation, combined with a medical culture that places doctors on a shaky pedestal where they must always be correct and confident, may explain why researchers find many doctors can exhibit dictatorial traits.
Fascinating research comparing physicians to autocratic regimes could serve as a wake-up call for a profession that’s already facing pressure from doctor shortages.
Motivated by Syrian President Bashar al-Assad’s background in medicine and the horrifying devastation under his leadership, two researchers and a medical doctor studied the possible similarities between autocratic leaders and physicians.
Shared Decision-Making
Shared decisions could shield patients and doctors against the dictatorial tendencies in the profession, the authors said, and also show respect for patient dignity. The end result could even lead to better patient outcomes. It appears the movement is gaining some ground.
The American Academy for Oral and Systemic Health recently held a training session on how health care professionals can help patients take ownership of their health by changing their approach to one of genuine curiosity. The session was taught by Bonnie Ripin, a dental hygienist.
“Telling people what to do doesn’t work,” warned Ms. Ripin. “It’s very important we keep an expansive and non-judgmental mindset as we remember we don’t know everything. By no means are we experts on our patients’ lives.”
Ms. Ripin shared the story of how a patient who smelled of cigarette smoke told her that he was getting treatment for lung cancer. Rather than rushing to condemn his continued smoking, she asked questions about whether he’d quit smoking before and what was stopping him from doing so now.
She discovered he had quit for a couple of years but his treatment was making him nauseous, and he felt relief by smoking. By showing she cared and presenting other options, Ms. Ripin said she was able to talk him into trying alternatives for his symptoms that might allow him to quit smoking.
Caring Versus Controlling
Concerned communication is key, not just for health care providers working with patients but for anyone who wants to persuade their loved one to make a change or see a doctor.
Dr. Evans said that patients often feel they’ve been told the same thing for years, for instance, “You need to lose 20 pounds,” without the support to make the change. It doesn’t make sense to issue a command without learning about what they’ve tried, or even whether they agree, he said.
Instead, he would ask his patients how they feel about their weight and whether they think it’s contributing to their symptoms. If they do, they can have a conversation about options. Many people, he said, care less about a diagnosis and more about how they feel.
Family members can speak to loved ones in the same manner. Before bombarding someone with “you should” statements, Dr. Evans suggested asking them questions about their lifestyle and health goals.
Presenting different health options as an experiment or question to be explored, while showing you care can be more effective in helping someone to make lifestyle changes, he said. He also partners patients with a functional health coach who helps patients reset their thinking so they don’t dwell on what hasn’t worked in the past.
New Medicine Paradigm
Most patients want someone on their team who looks to use prescriptions and surgeries sparingly, Dr. Evans said. As chief of medical affairs at the Institute for Functional Medicine, he’s witnessing the increased demand for functional medicine.Functional medicine doesn’t set out to suppress symptoms but to identify the root cause of disease and address that for more lasting benefits.
High-level hospitals, such as the Cleveland and Mayo clinics, have added functional medicine practitioners on staff, he said. Hospitals and medical schools are also incorporating functional medicine courses in their training.
“Conventional medicine is now realizing it’s the new way to practice medicine or care for patients. But it’s something we, in the functional world, have been doing for 25 years,” Dr. Evans said. “We really are agents of change.”
That means, the authors argued, that doctors must allow informed patients to turn down tests and treatments without labeling their decisions as “wrong” simply because their values don’t align.
Ms. Ripin emphasized that a humble attitude seeks permission to offer opinions only after listening and learning about what’s valuable to patients. That posturing becomes a win-win from a clinical standpoint.
Health Has No End
From the patient’s perspective, change is unlikely if he or she isn’t motivated or willing to invest time and money in what is really a journey, not a quick fix. Health and wellness is a lifelong commitment, not a destination, according to Ashley Iovinelli, a certified health coach and owner and operator of Wheatgrass Warrior.
“While I do think we can cure certain diseases or ailments, that’s not the end of it,” she told The Epoch Times. “If you deal with one disease or something you are going through, you can’t just say, ‘I don’t need to worry about supporting my body anymore because I’ve been through that.’ It’s a constant process.”
Patients will have to accept the investment of their own time, too. Dr. Kyrin Dunston, founder of the Midlife Metabolism Institute and The Hormone Club, was initially surprised to discover she needed three hours a day to make inroads in her own healing.
Now that she’s coaching patients to follow suit, she told The Epoch Times that using a calendar journal to document time for a week often shows them how much wasted time they’re actually able to free up.
A Worthy Investment
Likewise, patients will need to budget additional money—and that almost always involves a change in attitude. Dr. Dunston said she used to shop for the cheapest prescriptions and specialists her insurance afforded because it seemed like the right thing to do.She now recognizes that mindset is cultural conditioning. When she decided to go all-in on her own health, she hesitantly forked out more than $500 each for two out-of-pocket tests and then more than $800 in nutraceuticals.
“It was jaw-dropping, but I realized at that moment I had a decision to make,” she said. “Either I’m going to stick with what I’ve been doing that doesn’t work and go back to taking drugs, or I’m going to invest in myself and stop complaining, and I’m going to recognize my health is my most valuable asset.”
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